Team physicians’ duties are to their patients as individuals, not to the team or
to the school. The physician must have proper consent to provide medical care
and must respect patient confidentiality. No matter how interested the coach
may be in a star athlete, he or she has no right to participate in the medical
care of the athlete without the patient’s permission. Medical decisions must be
made on medical grounds by the physician responsible for the care.

The most difficult decision in sports medicine is determining when to allow
injured athletes to play. The football player with a sprained ankle may miss
the entire season if his activities are limited for as long as is usual in
nonathletes. If he is allowed to play too soon, he has a greater chance of
reinjuring the ankle and being disabled for a longer time. Blanket prohibitions
on play for an extended period may encourage the athlete to ignore the
physician’s advice altogether. If the athlete is an adult who can understand the
risks of playing while injured, the physician may only need to provide accurate
information on the risks of continued play. If the athlete is a child, the situation
is more complicated. The parents must be involved in the decision and must be
given full information about the risks.

When sports medicine physicians are dealing with athletes with less information
and support than are available to professionals, they should be more
conservative in balancing the need to get back to play against the probability
of impairing permanent healing. For example, if a sprain can be adequately
supported by tape, the athlete should be taught to tape and be allowed to
play. If an injury would heal without surgery but surgery will speed the
process, the athlete may choose to be operated on. Although a physician may
aid a professional athlete in a calculated decision to compromise future healing
for short-term gain, this should not be done for college and high school
players. Using pain killers or steroids to get the player back on the field when
this endangers permanent recovery is bad medicine and legally risky. The
promising player who wants to be in the game when the pro scout is there will
not be grateful if that game is his last because his injury becomes permanent.